433 Outcome measures demographics and characteristics in predicting hand eczema severity in atopic dermatitis patients
Authors: Archana Samynathan, Jonathan I Silverberg
Journal: British Journal of Dermatology (2023)

Abstract Hand eczema (HE) although is a simple umbrella term used in diagnosis, is a heterogeneous disease entity with multifactorial causative factors including irritant and allergic contact dermatitis (ICD and ACD, respectively) and atopic dermatitis (AD). An underlying defect in the skin barrier dysfunction driving AD is also a substantial explanation for not only encouragement of percutaneous penetration of allergens and irritants but also activation of local immune system seen in HE. This might also explain why ACD is often preceded by ICD. Atopic dermatitis is an established risk factor for HE with a strongly increased prevalence of two to fourfold including positive associations between AD and occupational HE. Hand eczema has a wide clinical spectrum; patients with hand eczema and AD have different clinical and epidemiological characteristics compared with hand eczema patients in general population. Identifying clinical cues, performing appropriate patch tests and determining presence of atopy is critical for assessing the severity and burden of HE, thus heavily influencing management paths and occupational choices. This study aims to explore objective (physician assessed) and subjective (patient assessed) outcome measures, demographic determinants and clinical findings in predicting the severity of hand eczema in patients with a definite diagnosis of atopic dermatitis. Database was created from patient filled questionnaires and analysed using SAS 2023 software. Objective physician assessments EASI, BSA, IGA, SCORAD and subjective patient assessments O_SCORAD and PtGA, demographic determinants including age at presentation and onset, race, gender, insurance types and clinical features were explored in predicting the severity of HE. A total of 1170 patients with were examined. Severity in IGA had clear association with severity on HE with stronger predictability in Moderate and Severe IGA (P &amp;lt; 0.0001 with 95% CI). Amongst patients with clear to almost clear IGA (score = 0), (98.3%) of patients with did not have HE, (0.9%) had mild HE, (0.4%) had moderate HE and (0.4%) had severe HE. Amongst the patients with a mild IGA score of 1, 95% did not have HE, 3.3% had mild HE, 1.1% had moderate HE and 0.4% had severe HE. Amongst the patients with a moderate IGA score of 2, 88.1% did not have HE, 8.8% had mild HE, 2.8% had moderate HE and 0.4% had severe HE. Amongst the patients with a severe IGA score of 3, 69.2% did not have HE, 16.7% had mild HE, 12.6% had moderate HE and 1.5% had severe HE. A total of 1258 patients at the time of presentation were analysed for demographic data. Seventy-one patients belonged to the pediatric (&amp;lt;18 years) age group, and 1187 patients were middle aged (18–49 years); of the pediatric patients, 76% had no HE, 16.9% presented with mild HE, 4.2% presented with moderate HE and 2.8% with severe HE. Of the adult patients 90.06% had no HE, 6.0% presented with mild HE, 3.4% presented with moderate HE and 0.6% with severe HE, showing predilection towards pediatric age (P = 0.05). Age of onset was a positive predictor with (P = 0.055) showing predilection for pediatric age of onset. There was no bias in gender to predict the severity of HE (P = 0.4, 95% CI). The types of insurances held by patients did not influence the severity of HE either (P = 0.8, 95% CI).Race of individuals to a certain extent determined the severity of HE with African American (P = 0.0003. 95% CI) and white races being strong determinants. The white race showed strong predictability with (P = 0.0493, 95% CI) when compared with the nonwhites. Erosions determined prediction of HE severity (P = 0.03, 95% CI). Erosions were found to be absent in 97.4% of the total patients, 30.5% were patients with no HE, 33.3% were patients with mild HE, 27.9% were patients with moderate HE and 7.2% were patients with severe HE. Of the total patients who presented with erosions 2.63%, 66.7% were patients with moderate HE and 33.3% were patients with severe HE, erosions were absent in milder HE severity. Wrist involvement also determined prediction of HE severity (P = 0.0039, 95% CI). Wrist involvement was found to be absent in 87.7% of the total patients, 34.0% were patients with no HE, 33.0% were patients with mild HE, 27.0% were patients with moderate HE and 6.0% were patients with severe HE. Of the total patients who presented with wrist involvement 12.3%, 7.1% had no HE, 28.6% had mild HE, 42.9% had moderate HE and 21.4% had severe HE. The other clinical features analysed, xerosis, redness, edema and papulation, erythema, scaling, fingernail involvement and vesiculation did not contribute significantly to predicting the severity of HE. Atopy has a causative role and is an established risk factor for Hand eczema. Atopic dermatitis is known to accelerate occupational or recreational exposure to allergens and irritants. In coexistence of AD and HE, AD scores help in assessing the severity and burden of HE thus aiding clinicians in making recommendations for its management particularly lifestyle modifications and occupational decisions.